Avaliação da Qualidade do Serviço de Triagem Auditiva Neonatal de uma Regional de Saúde do Paraná

Abstract

Neonatal Hearing Screening Programs (NHSPs) are essential for the early detection of hearing loss (HL) and for ensuring timely diagnosis and intervention, thereby reducing adverse impacts on child development. Despite their importance, these programs face barriers that limit their effectiveness. This study aimed to evaluate the quality of the NHSP in a Health Region of Paraná, Brazil, considering the dimensions of structure, process, and outcomes according to Donabedian’s framework. The research consisted of an integrative review and an evaluative study. The review was conducted using PubMed, SciELO, and the Virtual Health Library databases, with study selection performed by two independent reviewers and synthesis of findings organized according to Donabedian’s framework. The evaluative study included documentary analysis of DATASUS data, collection of information from the Regional Health Department, and a field study conducted at the regional hearing healthcare referral service. The field study was carried out in two stages. In the first stage, a cross-sectional design was adopted, and an initial questionnaire was administered to parents and/or caregivers of children receiving care at the service in order to characterize aspects related to structure, process, and outcomes. Caregivers of children in institutional care were excluded. A total of 63 caregivers participated in this stage. The second stage employed a longitudinal qualitative design. Among the participants from the first stage, only caregivers of children who had received a “refer” result on neonatal hearing screening and were younger than six months of age at the time of the initial data collection were selected. These participants were followed for two months via WhatsApp. Follow-up questionnaires were administered after hearing related appointments, and a final questionnaire was applied to assess perceptions of the care pathway, characterizing a case study design. Two participants remained in the study until its completion. The results revealed weaknesses across all three Donabedian dimensions. Regarding structure, limited availability of screening sites, shortages of professionals, a high dependence on outsourced services, and the absence of an integrated information system were identified. In the outcomes dimension, estimated coverage rates were below recommended levels, and delays in completing neonatal hearing screening were observed. In the process dimension, inconsistencies in care referrals were identified, affecting the timing of diagnosis and intervention. Longitudinal follow-up revealed communication failures, diagnostic delays, and variations in family satisfaction throughout the care pathway. The findings were consistent with the results of the integrative review, which demonstrated that NHSPs worldwide present limitations in structure, process, and outcomes, as well as recurrent delays in audiological diagnosis. It is concluded that the evaluated NHSP demonstrates compromised quality resulting from interdependent weaknesses across structure, process, and outcomes. Structural limitations directly affect care processes, generating delays, coordination failures, and difficulties in continuity of care, resulting in indicators below recommended standards. These findings highlight the need to reorganize care pathways, strengthen regional management, improve information systems, and expand access in order to ensure timely diagnosis and intervention for children with suspected hearing loss.